8-Week Yoga Protocol for Lung Cancer

8/7/2019 8-Week Yoga Protocol for Lung Cancer

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8-Week Yoga Protocol for Lung Cancer

Vijai Sharma, PhD

Introduction

We present a comprehensive yoga program in Viniyoga1

tradition, which includes Yoga poses (asanas), breathing techniques

(pranayama), meditation, mindfulness and relaxation techniques. This

protocol was developed by Vijai Sharma in consultation with Gary

Kraftsow at the request of Wayne State University, Nursing

Department research team for non small lung cancer post treatment

patients.

Yoga teacher may have to make necessary modifications

respecting the health and fitness of the participants in the group.

The program consists of two manuals: 1) Participant Manual 2)

Teacher Manual. Each manual provides instructions and details of the

exercises.

Towards the end of each manual, there is a Weekly Self-Care

Home Practice table to assist you plan the home yoga practice

Copyright: Vijai Sharma, PhD 2009

1 Viniyoga, a school of yoga derived from the ancient yogic lineage that specializes in modifying classical

yoga techniques for therapeutic needs of individuals.


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Participant Manual

In the course of this 8- sessions yoga program, we will provide you

the following important tools for strength and flexibility, better

breathing and some relief for fatigue and insomnia. Tools that can truly

nurture the breath, body and mind

Pursed-Lip Breathing (PLB) with abdominal breathing to moreeffectively empty the air out of lungs, reduce shortness/ breathingdiscomfort during rest and exertion and for reduction of breath related

anxiety and stress

Breath-coordinated exercises (Yoga asanas) for flexibility, strengthand breathing efficiency during exercise and exertion

Slow breathing and improved exhalation-inhalation ratio with yogabreathing exercises (pranayama)

Mental, physical and breath relaxation, and stress management throughsuch techniques as Quick Relaxation and Relaxed Breathing (Q.R. &R.B.), Breath-Mediated Body Scan, and Heart and Lung Tune-up

Part I,

Mood improvement with Heart and Lung Tune-up Part II Strengthening of breath awareness and mind body relationship with

Breath-Mediated Mindful Walking.

Suggested Use

For problems such as insomnia, lack of energy, fatigue, worries, blues, some

techniques may work better for you than the others. Likewise, you may have instantliking for some and others may grow on you as you practice them over and over

again. Try them all a few times in order to select the ones that are particularly

effective for you. Here is a guideline for your consideration:

Quick Relaxation and Relaxed Breathing (Q.R. & R.B): Abdominal breathingconstantly to ensure correct breathing

Asana/Pranayama practice: Once a day or more for strength, flexibility, breathingefficiency and stress relief

Breath-Mediated Body Scan: waking up; bed time; other time for relaxation andstress relief and breathing efficiency

Heart and Lung Tune-up Part I: once a day or more for sleep and relaxation Heart and Lung Tune-up Part II: once a day or more for mood improvement and

emotional and mental relaxation

Mindful Walking: once a day or more for coordinating breathing with movementsand presence

PLB as needed to prevent or control of breathing discomfort/shortness of breathNote: The 8-Week session is provided on the next page.


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12 Counted breathing with

breath awareness

10 breaths

Copyright: Vijai Sharma & Gary Kraftsow 2009. Revisions Tracy Flynn 2009.


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Session 2 - Yoga Class Practice. October 17, 2009

1 PLB/abdominal breathing

instructions

(seated)

6-12 breaths

2 Arm raises (seated) 3 x each

3 Spinal flexes (seated) 6 x

4 Chest expander (seated) 6 x

5 Forward bend (seated) 3-6 x

6 Side bend (seated) 3 x right

3 x left

7 Cow-child (kneeling) 6 x

8 Bridge pose (supine) 6 x

9 Knee to chest (supine) 6 x

10 Breath-Mediated Body

Scan (supine)

4-5 minutes

11 Savasana (RelaxationPose)

3-4 minutes


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12 Counted breathing with

breath awareness

10 breaths



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1 Q. R. & R.B. instruction(seated)

6-10 breaths






3 x left


8 Warrior Pose (standing) 3 x on each leg

9 Standing pose (standing) 3-6 breaths


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10 Forward bend (standing) 3-6 x





15 Breath-Mediated Body

Scan (supine)

4-5 minutes

16 Savasana (RelaxationPose)

3-4 minutes

17 Humming breath 6 breaths

18 Mindful Walking Introduce

* Items in the bold indicate that it was new or changed item from the previous weeks protocol



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1 Q. R. & R.B. instruction

(seated)

6-10 breaths






3 x left

7 Spinal flexes(seated) 6 x

8 Warrior Pose (standing) 3 x on each

leg


after each sideof Warrior


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15 Breath-Mediated Body Scan(supine)

4-5 minutes

16 Savasana (Relaxation Pose) 3-4 minutes





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Session 5 - Yoga Class Practice. November 7, 2009


(seated)

6-10 breaths





6 Warrior Pose (standing)

higher arms was new

3 x each,

each side

7 Standing pose (standing) 3-6 breathsafter each side

of Warrior




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10 Tree (standing) 3-6 breaths




14 Breath-Mediated Body Scan(supine)

4-5 minutes


16 Vowel Singing

(seated)

2 x ahh

2 x eee

2 x ooo

17 Mindful Walking 3-4 minutes




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(seated)

6-10 breaths





6 Warrior Pose (standing) 3 x each,

each side

7 Standing pose (standing) 3-6 breathsafter each side

of Warrior

8 Tree(standing) 3-6 breaths2 x each side (1

x with hand on

chair, 1x

without)




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13 Vowel Singing

(seated)

2 x ahh2 x eee

2 x ooo

14 Heart & Lung Tune UpPart I & II (on joy)

5-6 minutes




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(seated)

6-10 breaths





6 Warrior Pose (standing)

highest arms was new

2 x each,

each side


after each

side of

Warrior




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10 Triangle (standing) 3 x each side






16 Heart & Lung Tune Up Part I

& II (on joy)

5-6 minutes




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(seated)

6-10 breaths





6 Warrior Pose (standing) 2 x each,

each side


after each side

of Warrior


9 Triangle(standing) 3 x each side


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14 Vowel Singing 2 x ahh

2 x eee

2 x ooo

15 Heart & Lung Tune UpPart I & II (on love) 5-6 minutes




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Participants

Breath-Mediated Mindful Walking (5-10 minutes)

Do mindful walking at least once a day or more for additional benefits

In nutshell: Keep the breath in the abdomen and the mind on walking

Potential Benefit: With mindful walking, you may feel calmer and centered and be able to pace your walking with your

breathing. Such pacing between walking and breathing may increase the efficiency of your breathing and improve your staminafor walking.

Mindful walking involves body awareness and breath awareness as you walk. If you experience shortness of breath you mayslow your walking in order to control shortness of breath.

Before you start walking, check your breath to make sure you doing abdominal breathing. Do Pursed Lip Breathing, if desired.

Drop any unnecessary tension other than the muscle tension required in order to walk. If you notice excessive tension in any

part of the body, relax.

Remember to blow as you go. Exhale while slightly pulling in your abdomen towards the back as you walk. The moment youbegin to notice breath shifting from abdomen to upper chest, slow the pace of walking. Regulate your breath. Do PLB if desired

or rest for a while.

Dont compete with yourself or anyone else. It does not matter how FAR you walk but how LONG you walk and how WELL

you breathe during your walk in spite of the breathing challenge you face.



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Participants

Pursed-Lip Breathing (PLB)

Imagine smelling a rose (Inhaling slowly) blowing at the candle like you are bending or flickering the flame but not soforcefully as to put out the candle. Imagine blowing softly, gently and slowly. If possible, exhale while gently

contracting your belly towards the back

Relax your shoulders and neck. Pucker your lips as if you were going to whistle or kiss a baby. Softly, VERY GENTLY, and s-l-o-o-w-w-ly breathe out through the pursed lips. If possible, breathe out through bothsides of the lips. Breathe in slowly through your nose. Do not force air out of your lungs. Blow out the breath softly. Make your exhalation longer than inhalation. However, increase the length of exhalation

gradually. Exhaling longer than your capacity could make the next breath jerky. If your breathing gets agitated, take abreak.

PLB with Abdominal Breathing

Now you know how to do PLB and you also know how to do abdominal breathing. PLB combined with very gentlecontraction of abdominal muscles can be even more effective. Follow these instructions:

Slightly, very gently, pull in the navel towards the back, purse your lips and start exhaling slowly with a gentle and consistent

pressure. Do not exert or forcibly contract the abdominal muscles as that can tire you out quickly. Just a mild suggestion to theabdominal muscles for gently pulling in the navel towards the back is good.

PLB with inhalation-exhalation ratio (desirable for some people)

Count in your head as you inhale and exhale so you can keep track of the length of breath. Always breathe slowly and softly.

When possible, breathe in through the nose and breathe out through the pursed lips.

The ratio of inhaling to a count of 4 and exhaling to a count of 6 is good for most of the time. However, if lungs are hyper inflated,

you may gradually make your exhalation twice longer than inhalation. For example, if possible, inhale to a count of 5 and exhale to a

count of 10.

Dont try to inhale longer than exhale!


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Participants

Quick Relaxation and Relaxed Breathing ((Q.R. & R.B.) 6-10 breaths

Introduction:

You may try it for quick relaxation and to restore relaxed abdominal breathing. If you are tense breathing becomes worse. It is

important to quickly relax especially the face, neck and shoulders and restore do relaxed abdominal breathing. This can also help withshortness of breath and any other breathing discomfort you may have.

Q.R. & R.B: Face relaxed! Neck and shoulders relaxed! Body relaxed! Hand on abdomen! Abdominal breathing!

Take 6-10 breaths in this manner!


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Participants Breath-Mediated Body Scan (4-5 minutes)

Introduction: You may use it for relaxation, stress management, insomnia and fatigue. When to do it? Waking up; going

to bed; at night when sleep is interrupted and other times when deeper relaxation and/or slow, smooth breathing is desired.

Instructions: Simply exhale and relax the part of the body I say. As you exhale, make that part of the body real loose andrelaxed!

Exhale and relax the forehead and the eyes

The nose and the mouth

Entire face

The neck and the throatExhale and relax both shoulders and shoulder blades

Entire right arm including the finger tips

Entire left arm including the finger tips

Exhale and relax the chestAbdomen and the pelvis

Right leg from hips to toes

Left leg from hips to toes

Exhale and relax the entire right side of the body

Entire left side of body

Exhale and relax the lower bodyThe upper body

The front of the bodyThe back of the body

Exhale and relax the inside of the bodyThe outside of the body

Exhale and relax the entire body!

Become aware of the whole body. Whole body awareness from toes to head and head to toes!

As you breathe in and out, be aware of the whole body, toes to top and top to toes! Hands to the head and head to the hands!

To end the Body Scan Practice: Become aware of your surroundings. In your minds eyes, see the room where you are lying

down. Close and open your fists. Squeeze and spread your toes. Gently open your eyes. Turn on your preferred side and

prepare to get up slowly.

Alternate instruction for Breath-Mediated Body Scan: Inhale and become aware of the part of the body I say. Then exhale and

relax that part of the body. For example, when you hear, The forehead and the eyes, inhale and scan the forehead and the eyes.Then exhale and relax the forehead and the eyes. Continue with the rest of the body parts in that manner.



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Participants

Heart and Lungs "Tune-Up" Part I (1-2 minutes)

Introduction: Heart and Lung Tune up is a tonic for the lungs and the heart, and a tool for relaxation, stress management, better

sleep and relief from fatigue. Heart and Lung Tune Up Part I can be done with or without the Part II

Starting Position: lying down or sitting on the chair or the floor.

If you lie down, keep a pillow under your head. If you sit in a chair, sit a little forward on the seat, keeping head, neck and trunk in a

straight line. If you sit on the floor, keep a folded blanket under your sitting bones and keep head, neck and trunk straight.

Technique

1. Leave the whole body loose and relaxed.2. As you INHALE, imagine as if the breath is entering through the crown of the head and going down into the heart

center. While inhaling, say to yourself silently, Calm

3. As you EXHALE, relax the body even more loose and relaxed while imagining the breath is exiting from the heartcenter all the way down and out through the toes and the soles of the feet. While exhaling, say to yourself, silently,

Relaxed. With each exhalation, let the body become even more loose and relaxed.

Take 6-10 breaths in this manner. If you wish, you may continue doing it longer.

Note: If you wish, you may go on to do Heart and Lungs Tune up Part II

. Copyright: Vijai Sharma, PhD 2009


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ParticipantsHeart and Lungs "Tune-Up" Part II (5-6 minutes)

Introduction In the Heart and Lungs Part II, we select a positive emotion such as joy, love, compassion, gratitude, etc. and

experience it as fully and vividly as we can.

Why do it? Heart and Lungs Part II is a mood improver. It will take you out of negative mood into a positive mood and

feeling and work as a tonic to youre your spirits. It is not only a tonic for your feeling heart but also a tool for breathrelaxation and stress management. Experience it!

When to do the Heart and Lungs Part II? After you have done Heart and Lungs Tune-Up for a few breaths in which youhave inhaled as if through the crown of the head into the heart center and exhaled out from the heart center through the toes.

With each exhalation, you have let the body become even more loose and relaxed.

TechniqueFeeling the emotion of joy

Your breathing is becoming smooth, slow and quiet. For the purpose of this exercise, feel that you are totally content and

at peace. There is nothing more you want in the moment. You feel a sense of gratitude for what you have.

Start inhaling and exhaling from the heart center. Feel your heart is breathing in and out in a relaxed manner. Your heart

gently opens up with the in-breath and relaxes with the out-breath. Let that smile from the heart flow to the eyes. Smile with

your eyes and face. Notice when you smile with your eyes, how they brighten up! Perhaps, you may recall a specific time andplace when you felt immensely joyful. Were you by yourself or with someone when you felt happy and joyful? Were those

moments of happy conversations, smiling faces, laughter or tears of joy? Experience it all over again with the same intensitynow!

Let the feeling of joy from the heart and the eyes flow over into the rest of the body. Feel the feeling of joy in the whole

body! (here, pause for 1 minute)

To end the practice: Become aware of your surroundings. In your minds eyes, see the room where you are lying down.

Close and open your fists. Squeeze and spread your toes. Gently open your eyes. Turn on your preferred side and prepare to get

up slowly.

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You may choose other positive emotions. Here are two more examples:

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Feeling love: You may choose to experience love for your partner, sibling, friend, child, or the love for everyone, the love

for humanity or God. Having established relaxed heart-breathing, feel the emotion of love in your heart! Perhaps your heartsoftens and opens up when you vividly experience the changes in the body and the heart when you experience love. Recall a

specific time, place and person when you felt the love in your heart. Re-experience that love in this moment. What were all the

feelings you were feeling towards the person you intensely loved? Was there happiness, joy, sensation of thrill, an emotional

high or some feelings along those lines? Let the love feeling from the heart flow over to the face and the whole body.

Feeling compassion: Imagine a person who is less fortunate than you are, or has less than you do. Perhaps, this person isvery sick and needs your help. Having established the relaxed heart breathing, bring that person in your heart. See yourself

helping that person with such things as cooking, giving medicine, pushing the wheelchair, bringing flowers or doing another act

of compassion and help. Feel the kindness and compassion and the joy of helping that person.



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Participants

Relaxation Pose (Shavasana) 3-4 minutes

IntentionWhether sitting or lying down, find the most comfortable position in which you can be still and comfortable for 3-4

minutes. Lie down and be still. Observe your breathing. Let the breathing become slow and smooth without trying to change it.


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Teacher Manual

Teacher Manual consists of the following:

A- Handouts to be given to the Participants

Quick Relaxation (Q.R.) and Relaxed Breathing (R.B.) Pursed-Lip Breathing (PLB) Breath-Mediated Body Scan Heart and Lung Tune-up Part I Heart and Lung Tune-up Part II Breath-Mediated Mindful Walking

B- Audio Tape/CD to be recorded by the teacher in his/her voice for participants use

Breath-Mediated Body Scan Heart and Lung Tune-up Part I Heart and Lung Tune-up Part II Breath-Mediated Mindful Walking

C- Detailed instructions for all exercises to be performed by the participants.


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Teacher

Quick Relaxation and Relaxed Breathing (Q.R. & R.B.)

Introduction:

Breathing discomfort makes us tense and tension makes the breathing worse. Physical and mental relaxation can improve our

breathing. It is important that we learn to relax quickly especially the face, neck and shoulders and do relaxed abdominal breathing.This can also help with shortness of breath and any other breathing discomfort you may have.

Here are the instructions that may be given at the first session. Thereafter, brief instructions may be given for subsequent session.

Quick Relaxation (Q.R)

Relax your entire face. Relax your throat and neck. Relax your shoulders and shoulder blades. Relax your entire right arm. Relax

your entire left arm. Relax your chest. Relax your abdomen and pelvis. Relax your entire right leg. Relax your entire left leg. Relax

the whole body.

Relaxed Breathing (R.B.)

Relaxed breathing is abdominal breathing with neck and shoulders relaxed. Keep your neck and shoulders relaxed.

Put your one hand on chest and the other one on your abdomen. Let your abdomen become soft and relaxed. Neck and shoulder

remain quiet and relaxed as much as possible. As you inhale the hand on the chest remains moves as little as possible and the hand onabdomen moves up (or outwards, if sitting). As you exhale, the abdomen contracts and the hand on the abdomen is pulled in towards

the spine. Breathe softly and slowly. This is abdominal breathing. Keep the upper chest and abdomen relaxed as you breathe in and

out.

Brief instructions for the subsequent sessions: Face relaxed! Neck and shoulders relaxed! Body relaxed! Hand on abdomen!

Abdominal breathing! Take 6-10 breaths in this manner!

Teacher

Additional Notes on Asana-Pranayama Tables

Breath-Mediated Mindful Walking: Instructions and actual practice for the Breath-Mediated Mindful Walking is conducted prior to

the beginning of the asana pranyama class.

PLB: Detailed instructions are provided in the 1 st session. Further refinement of the skill may be needed in the subsequent sessions

Spinal Warm-Up (spinal elongation; FB; BB; LB; Twist with arm movements): Intention: For those, who cant get on the floor totally

or cant use supine or prone position due to diaphragmatic issues, may at least be able to move their spine in the five directions withcoordinated breathing. For others, it would be a nice warm up for subsequent asanas. It is a safe way to start the first class to allow

the yoga instructor some time to know everyones fitness level and specific physical-structural issues.

Quick Relaxation and Relaxed Breathing (Q.R. & R.B.): Detailed instructions are provided in the 2nd session. Brief instructions andrefinement of the skill is provided from session 3 to 8

Forward Bend/PLB: To be used as per teachers discretion anywhere between session 2 to 8 or deleted altogether

Pranayama: Counted Breathing; Humming Breath; Vowel Singing

Note: These three ancient pranayama (yoga breathing techniques) are for expiration prolongation, that is, they can increase the length

of your exhalation which can also help to slow the breathing and increase the efficiency of both inhalation and exhalation.


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You do not have to do all three at one time. You may do just one or two of them. You do not have to do each one for 6-10 times.You may want to do just 3 or more of one, two or all three of the breathing techniques.

(Sitting) Counted Breathing (6-10 breaths): Each time as you exhale, count the silently in your head the serial number of

exhalation.

Example: While exhaling softly and slowly, say silently One. Inhale slowly and smoothly. While exhaling softly and slowly nexttime, say silently Two. Inhale slowly and smoothly. While taking next exhalation softly and slowly, say silently Three.

In this manner, go on silently counting the number of exhalation. Inhale slowly and smoothly.

(Sitting) Humming Breath (6-10 breaths): In a seated position, press the tip of your tongue against the hard palate and make a soft

humming sound such as hummm.. As you begin to approach the end of your exhalation, exhale without the humming sound.Each time, inhale slowly and smoothly.

Optional--Instead of producing humming sound of the beetle, if you prefer, you may sing a short line of your favorite song. Again, as

you approach the end of your breath, exhale without the humming sound.

Sitting) Vowel Singing (6 breaths): In a seated position, sing the vowels (Ah, EE and OO) slowly and gently. As you begin to

approach the end of your breath, exhale softly without the vowel sound.

. 2 xEEEE. 2 x

0000.. 2 xOptional: Instead of vowel singing, you may want to do Om chanting. While saying, softly chant ommm.. Inhale softly and

slowly.


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Teacher

Form the Habit of Conscious Breathing

As you begin to pay steady attention to your breathing, it will be easier for you to monitor your breathing. Any time you

find yourself holding your breath or having a jerky breath, breathing irregular or faster, go back to belly breathing

Pay attention to your breathing. While inhaling move your attention downward and follow the lungs filling, chestexpanding horizontally and vertically and the belly bulging out. While exhaling, move your attention upward from abdomen to chest,

notice the belly and solar plexus slightly contracting and the breath finally exiting through the nostrils.

Make it a habit to breathe consciously. Conscious breathing can be very beneficial. Develop positive and relaxed

awareness of your breathing.

Let me take an example of conscious driving in order to make a point about conscious breathing. While driving, even

when you use the cruise, you continue to monitor the road conditions all the time. Likewise, you should monitor your breathing evenwhen you get into the automatic mode of breathing. When you monitor the breath, you can decide when you want to leave your

breathing on the "automatic pilot" and when to take charge and regulate your breath with awareness



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Teacher

Conscious Breathing/ Relaxed Breathing

Vijai Sharma PhD, RYT

When you physically, mentally and emotionally relax your breathing can be naturally slow, deep and relaxed. Put yourself

in a state of relaxation prior to practicing relaxed breathing.

Signs of relaxed breathing

Neck and shoulders relaxed Belly breathing Slow breathing Smooth and rhythmical breathing Quiet breathing No long pauses or jerks between breaths Exhalation is equal or longer than inhalation.

DURING INHALATION

Neck and shoulders remain relaxed. As the breath goes downward, the chest expands, the rib cage elevates, diaphragm

goes down and the belly comes out. The area between sternum, navel and perineum feels stretched. The upper back widens and the

lumbar arch slightly deepens.

DURING EXHALATION

Neck and shoulders remain relaxed. Diaphragm relaxes, chest and ribcage retract to their pre-inhalation size and position,the belly goes in, navel slightly pulled in towards the back and the lumbar arch in the low back slightly flattens.

Helpful Tips for Relaxed Breathing

Practice relaxed breathing several times a day for a few minutes at a time Schedule several one minute relaxed breathing moment during the day, when you quickly relax, focus on your belly or

forehead and trigger relaxed breathing

Learn physical and mental relaxation technique which would also facilitate relaxed breathingABDOMINAL BREATHING

Abdominal breathing can be practiced in a seated position or lying down position. If you sit in chair, come forward a little

so neck, head and trunk are straight and relaxed.If you experience trouble breathing while lying down, practice breathing technique while seated in a comfortable position

Of course, breathing is done by lungs, the term abdominal breathing is used to remind us that we should focus on the

abdominal movement during the breathing. Abdomen expands during inhalation and contracts during exhalation. When you inhale,

diaphragm pushes down and with that it pushes down the abdominal organs and as a result of this action, the abdomen bulges out.When you exhale, diaphragm relaxes and goes up. With such diaphragmatic action, abdomen contracts, the abdominal organs which

were pushed down come back up and you notice that the abdominal wall pulls in towards the back.

In nutshell, in order to do abdominal breathing, pull the abdomen in towards the back while exhaling and let the

abdomen expand while inhaling.

Use the hand Technique

Sit in a quiet place and just settle down for a minute or two. Put your hand, horizontally, about one inch above your navel.

Close your eyes. Breathe normally without trying to influence your breathing one way or the other. Observe how your belly moves

every time you breathe in and breathe out. If you are breathing correctly, you should find that the hand over the tummy moves out as

you breathe in and moves in as you breathe out.


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This is called, abdominal breathing (or belly breathing informally). Abdominal breathing is good but dont deliberatelypuff your belly out. Let the belly be relaxed as you inhale.

If upper chest and/or shoulder and neck go up and down as you breathe in and out, let your neck and shoulder relax. Whenyou are sitting quietly and breathing, your neck and shoulders remain still if you are breathing correctly.

Close your eyes again and track your hand on the belly.

Belly should bulge OUT when you breathe IN

Belly should pull IN when you breathe OUT.

Tips for Correcting abdominal Movement

If the abdomen does not move correctly as for example, abdomen moves in when you inhale, you need to correct it. Here

is how:

Take a slow, deep breath in and breathe out slowly and steadily. The next breath will come in automatically, that is

without your effort. Your tummy will move outward as you breathe in and move inward as you breathe out.

If your abdomen begins to move incorrectly or not move at all or only chest moves but not abdomen, relax and reestablish

correct breathing. Take a deep, slow, easy breath and blow it out, slowly and steadily. Do it as many times as you need to. Abdomenwill begin to move correctly with a few repetition unless there is a structural problem.

Abdominal and relaxed breathing beneficial for breathing, anxiety and depression

Abdominal Breathing

When you breathe in, abdomen expands and protrudes.

When you breathe out, abdomen pulls in towards the back.

While breathing in, observe the descending diaphragm and expanding lower ribs and abdomen

During exhalation, observe the diaphragm ascending and abdomen contracting and pulling in towards the back.

Pay gentle attention to this process and not get frustrated if it does not happen right away as described here.

In case of relatively flattened diaphragm and shortened intercostals (true for many people with COPD), gently contract the abdomen

and lower ribs during exhalation. By doing so during exhalations helps your diaphragm to move upward and empty the lungs more

efficiently.

During inhalation, as the diaphragm moves down, simply allow the abdomen and lower ribs to expand.



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Teacher

Pursed Lip Breathing for Shortness of Breath

Vijai Sharma PhD, RYT

Pursed -Lip Breathing (PLB) is one of the most helpful things you can do when you are feeling breathless. PLB helps to keep the

breathing tubes (bronchi) open and maintain right pressure in those tiny, tiny air sacs. Furthermore, mouth is closer to lungs than thenose is, so its easier to blow the breath out through the mouth.

Benefits of PLB

1. Reduces breathlessness2. Slows the breathing rate3. Lengthens the exhalation4. Helps to empty the stale air out of the lungs5. Increases the size of your breath volume

Set a goal to breathe consciously for most part of your waking hours. If you experience any breathing problem or irregularity in yourbreathing, start practicing PLB. Your continued breath awareness and monitoring will prompt you at the earliest sign of irregular

breathing. The moment you notice the first sign, start practicing PLB to regulate your breathing.

Instructions for PLB

Relax! Lean slightly forward and s-l-o-w-l-y blow out through pursed lips as if gently blowing a kiss at someone or cooling

the hot soup in the spoon for the baby, gently and steadily. If possible, exhale while gently contracting your belly towards the back.

You may breathe in through the nose, if possible, and breathe out through the pursed lips. The action of leaning slightly

forward and blowing out against pursed lips encourages the contraction of abdominal muscles, thereby forcing the diaphragm upwardto empty the lungs more completely.

People with COPD tend to cut short exhalation in a hurry and rush to swallow more air, which can make breathlessness

even worse. PLB slows down exhalation and assists with the action of emptying the lungs and may also help strengthen the breathing

muscles.

Lengthen your exhalation. Silent counting while exhaling and inhaling can help. To begin with, you may inhale for a count

of three or four, and exhale for the same count. As you progress and the breath stabilizes, you may lengthen the exhalation to a count

of six or eight. An ideal ratio for the length of inhalation to exhalation for some people is 1: 1.1/2 and for some it is 1:2

Remember about the length of inhalation and exhalation

It is generally better to exhale longer than inhaleUnder some situations such as when breath is unsettled, if it is not possible to exhale longer than inhale, exhale and inhale for

equal length

But, do not inhale longer than you exhale.

Pursed Lip Breathing (PLB)

1. Imagine smelling a rose (Inhaling slowly) blowing at the candle like you are bending or flickering the flame but not so forcefully

as to put out the candle. Imagine blowing softly, gently and slowly. If possible, exhale while gently contracting your belly towardsthe back

2. Relax your shoulders and neck.

3. Pucker your lips as if you were going to whistle or kiss a baby.

Softly, VERY GENTLY, and s-l-o-o-w-w-ly breathe out through the pursed lips. If possible, breathe out through both sides of the

lips.4. Breathe in slowly through your nose.

5. Do not force air out of your lungs. Blow out the breath softly.

6. Make your exhalation longer than inhalation. However, increase the length of exhalation gradually. Exhaling longer than yourcapacity could make the next breath jerky. If your breathing gets agitated, take a break.

7. Count in your head as you inhale and exhale so you can keep track of the length of breath. Always breathe slowly and softly.

8. When possible, breathe in through the nose and breathe out through the pursed lips.9. The ratio of inhaling to a count of 4 and exhaling to a count of 6 is good for most of the time. However, if lungs are hyper inflated,

you may gradually make your exhalation twice longer than inhalation. For example, if possible, inhale to a count of 5 and exhale to a

count of 10.

10. Never try to inhale longer than exhale!


PLB with Abdominal Breathing


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Now you know how to do PLB and you also know how to do abdominal breathing. PLB combined with very gentle

contraction of abdominal muscles can be even more effective. Follow these instructions:

Slightly, very gently, pull in the navel towards the back, purse your lips and start exhaling slowly with a gentle and consistent

pressure. Do not exert or forcibly contract the abdominal muscles as that can tire you out quickly. Just a mild suggestion to the

abdominal muscles for gently pulling in the navel towards the back is good.


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Self-Care Home Practice

Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7

Abdominal

breathing

(# of times)

Asana-Pranayama

Practice 1-12) (# of

times)

Body Scan &Whole Body

Breathing (#

of times)

Heart andLung Tune-

Up (# of

times)

Renewal &Healing:

Guidedimagery (# of

times)

Heart

MeditationMention

which

emotion e.g.

joy, love,

compassion,other---

Mindful

Walking (#

of times)Mindful

Moments

breath, body,

eyebrowcenter, heart,

activity, e.g.brushing,

cooking,

eating,

shower--? )PLB ( # of

times

needed)

Abdominal Breathing/PLB: Abdominal breathing constantly to ensure correct breathing Asana/Pranayama practice: Once a day or more for strength, flexibility and stress relief Body Scan/Whole Body Breathing: waking up; bed time; other time for relaxation and stress relief Heart and Lung Tune-up: once a day or more for sleep and relaxation Renewal and Healing: Guided imagery: pre-breakfast; other times for energy & mood elevation Heart meditation: once a day or more for mood improvement and mental relaxation Mindful Walking: once a day or more for coordinating breathing with movements and presence Mindful Moments: once a day or more for breaking the negative automatic thought pattern PLB as needed to prevent or control of breathing discomfort/shortness of breath


8-Week Yoga Protocol for Lung Cancer

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Transcript of 8-Week Yoga Protocol for Lung Cancer